IN THE MUNICIPAL COURT OF PERRYSBURG, WOOD COUNTY, OHIO IN THE MATTER OF ___________________________________ Applicant/Debtor * * * Case No. ______________________ APPLICATION FOR THE APPOINTMENT OF A TRUSTEE *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** Ohio Revised Code Sections 2329.70; 2716.02 The undersigned, whose place of residence is _______________________________________, _________________________, Ohio, upon whom a demand has been made in accordance with Section 2716.02 of the Revised Code of Ohio, respectfully makes application for the appointment of a trustee to receive that portion of the personal earnings of your applicant, the debtor, in the above entitled case, not exempt from execution, attachment, or proceedings in aid of execution, and such additional sum the undersigned debtor may voluntarily pay or assign to such trustee. Such trustee to distribute such funds as the Court or Judge may order. Applicant further states that he/she is employed by _________________________________ at _______________________, Ohio; His/her average weekly wage is ______________________________; He/she is paid on the (list day)___________________ of each week; The number of dependants residing with and whose age and relationship to applicant are: ______________________________; aged ________ years; ___________________________ (Dependant's Name) (Relationship to Applicant) ______________________________; aged ________ years; ___________________________ (Dependant's Name) (Relationship to Applicant) ______________________________; aged ________ years; ___________________________ (Dependant's Name) (Relationship to Applicant) ______________________________; aged ________ years; ___________________________ (Dependant's Name) (Relationship to Applicant) A full, accurate, and complete statement, under oath, of the names of the secured and unsecured creditors with liquidated claims, their addresses and amount due to each is herewith filed. Dated this _______ day of ____________________, 20___. Applicant/Debtor's Signature ____________________________________ American LegalNet, Inc. www.FormsWorkFlow.com